Is ozone therapy effective for treating shoulder pain?

Ozone Therapy for Shoulder Pain: Current Evidence and Recommendations

Ozone therapy is not recommended as a first-line treatment for shoulder pain as there is insufficient high-quality evidence supporting its efficacy over established interventions. 1, 2

Evidence Assessment

Current Guidelines on Shoulder Pain Management

Clinical practice guidelines do not include ozone therapy among recommended treatments for shoulder pain. Instead, they recommend:

• For prevention of shoulder pain 3:

  • Electrical stimulation to improve shoulder lateral rotation
  • Shoulder strapping/positioning devices
  • Staff education to prevent trauma to affected shoulders
  • Avoidance of overhead pulleys (which encourage uncontrolled abduction)

• For treatment of shoulder pain 3:

  • Intra-articular corticosteroid injections
  • Shoulder strapping
  • Range of motion exercises focusing on external rotation and abduction
  • Physical modalities: ice, heat, soft tissue massage
  • Functional electrical stimulation
  • Strengthening exercises

Ozone Therapy Research

Limited research exists on ozone therapy for shoulder conditions:

• A 2019 randomized controlled trial comparing ultrasound-guided ozone vs. corticosteroid injections for shoulder impingement found that while both treatments improved pain scores, corticosteroid injections provided superior improvement in pain and disability scores 2

• A 2023 study comparing intra-articular ozone injection with steroid injection for adhesive capsulitis found no statistically significant differences between the treatments, though both improved pain, function, and range of motion 4

• A 2023 scoping review noted that ozone treatment seemed to improve pain and function in upper limb musculoskeletal diseases but emphasized that protocols varied widely and further studies are needed 1

Treatment Algorithm for Shoulder Pain

1. First-line interventions 3, 5:

   • Proper positioning and supportive devices
   • Range of motion exercises focusing on external rotation and abduction
   • Physical modalities (ice, heat, soft tissue massage)
   • Acetaminophen or NSAIDs at lowest effective dose for shortest duration

2. Second-line interventions 3, 5:

   • Intra-articular corticosteroid injections
   • Functional electrical stimulation
   • Suprascapular nerve blocks (for hemiplegic shoulder pain)

3. Third-line interventions 3:

   • Botulinum toxin injections (for spasticity-related shoulder pain)
   • Intramuscular electrical stimulation
   • Surgical interventions when appropriate

Important Considerations

• Avoid overhead pulley exercises as they can worsen shoulder pain 3

• Corticosteroid injections provide superior short-term pain reduction compared to standard care, particularly when guided by imaging to verify joint pathology 3

• Acupuncture may be a safe and effective adjuvant for hemiplegic shoulder pain, though evidence is limited 3

• For adhesive capsulitis, both corticosteroid injections and ozone therapy showed improvements, but the evidence favors established treatments like corticosteroids 6, 4

Conclusion

While some emerging evidence suggests ozone therapy may have a role in managing certain shoulder conditions, current clinical practice guidelines do not recommend it as a standard treatment. The most recent and highest quality evidence indicates that traditional interventions like corticosteroid injections, physical therapy, and appropriate pain management remain the preferred approaches for shoulder pain management.